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1.  Consumer interpretation of ramipril and clopidogrel medication risk information – implications for risk communication strategies 
Side effects and side-effect risk information can be provided using written medicine information. However, challenges exist in effectively communicating this information to consumers. This study aimed to explore broad consumer profiles relevant to ramipril and clopidogrel side-effect risk information interpretation.
Three focus groups were conducted (n=18 consumers) exploring consumer perspectives, understanding and treatment decision making in response to ramipril and clopidogrel written medicine information leaflets containing side effects and side-effect risk information. All discussions were audio recorded, transcribed verbatim, and analyzed to explore consumer profiles pertaining to side-effect risk appraisal.
Three consumer profiles emerged: glass half-empty, glass half-full, and middle-of-the-road consumers, highlighting the influence of perceived individual susceptibility, interpretation of side-effect risk information, and interindividual differences, on consumers’ understanding of side-effect risk information. All profiles emphasized the importance of gaining an understanding of individual side-effect risk when taking medicines.
Written side-effect risk information is not interpreted uniformly by consumers. Consumers formulated their own construct of individual susceptibility to side effects. Health care professionals should consider how consumers interpret side-effect risk information and its impact on medication use. Existing risk communication strategies should be evaluated in light of these profiles to determine their effectiveness in conveying information.
PMCID: PMC4501347  PMID: 26185427
adverse effects; risk assessment; drug labeling; consumer participation; comprehension
2.  Provider Use of Collaborative Goal Setting with Glaucoma Patients 
The purpose of this preliminary study was to describe the extent to which providers used collaborative goal setting and individualized assessment with patients who were newly prescribed glaucoma medications.
English-speaking glaucoma suspect patients from six ophthalmology clinics who were newly prescribed glaucoma medications had their medical visits video-tape recorded and were interviewed after the visits. The video-tapes were transcribed and coded to examine provider use of collaborative goal setting and individualized assessment.
Fifty-one patients seeing 12 ophthalmologists participated. Providers gave patients glaucoma treatment options during 37% of the visits; only five providers gave patients treatment options Providers asked for patient treatment preferences in less than 20% of the visits; only two providers asked for patient treatment preferences. Providers were significantly more likely to ask African American patients for their preferences or ideas concerning treatment than non-African American patients (Pearson chi-square= 4.1, p=0.04). Providers were also significantly more likely to ask African American patients about their confidence in using glaucoma medication regularly than non-African American patients (Pearson chi-square=8.2, p=0.004). Providers asked about patient views about glaucoma in less than 20% of the visits; five providers asked patients their views on glaucoma and its treatment. Providers were significantly more likely to ask African American patients about their views of glaucoma than non-African American patients (Pearson chi-square=5.62, p=0.02).
Eye care providers often did not use collaborative goal setting or conduct individualized assessments of patient views of glaucoma when prescribing treatment for the first time.
PMCID: PMC4005354  PMID: 24705480
goal-setting; assessment; glaucoma; medications
3.  Development and Initial Evaluation of a Measure of Self-Management for Adults With Antineutrophil Cytoplasmic Antibody–Associated Small-Vessel Vasculitis 
Arthritis and rheumatism  2007;57(7):1296-1302.
To develop a measure of illness self-management for adults living with antineutrophil cytoplasmic antibody (ANCA)–associated small-vessel vasculitis (ANCA-SVV) and to gather evidence of its reliability and validity.
Development of the Vasculitis Self-Management Scale (VSMS) was guided by previous research on self-management in other chronically ill populations, a review of the current treatment literature for ANCA-SVV, interviews with patients, and consultation with experts. A total of 205 patients living with ANCA-SVV or a closely related condition then completed the VSMS, along with measures of sociodemographic and clinical variables, social desirability bias, and general adherence to medical recommendations, using a self-administered mailed questionnaire. A principal components analysis was conducted on the VSMS items. Internal consistency reliability and construct validity of the resulting subscales were assessed. Forty-four patients completed the VSMS a second time, for the purpose of assessing test-retest reliability.
Analyses suggested an 8-factor solution. The final VSMS consisted of 43 items representing these 8 behavioral domains. Correlations among the 8 domains were null to modest in magnitude. The internal consistency reliability of the 8 subscales ranged from minimally acceptable (α = 0.67) to excellent (α = 0.94), and correlations between subscale scores at time 1 and time 2 suggested good temporal stability. Preliminary evidence for validity was mixed.
These findings suggest that the VSMS is a promising method for assessing illness self-management in adults with ANCA-SVV. More research exploring the validity of the measure is warranted.
PMCID: PMC4049533  PMID: 17907222
Systemic vasculitis; Illness self-management; Health behavior; Psychometrics
4.  Provider Education about Glaucoma and Glaucoma Medications during Videotaped Medical Visits 
Journal of Ophthalmology  2014;2014:238939.
Objective. The purpose of this study was to examine how patient, physician, and situational factors are associated with the extent to which providers educate patients about glaucoma and glaucoma medications, and which patient and provider characteristics are associated with whether providers educate patients about glaucoma and glaucoma medications. Methods. Patients with glaucoma who were newly prescribed or on glaucoma medications were recruited and a cross-sectional study was conducted at six ophthalmology clinics. Patients' visits were videotape recorded and patients were interviewed after visits. Generalized estimating equations were used to analyze the data. Results. Two hundred and seventy-nine patients participated. Providers were significantly more likely to educate patients about glaucoma and glaucoma medications if they were newly prescribed glaucoma medications. Providers were significantly less likely to educate African American patients about glaucoma. Providers were significantly less likely to educate patients of lower health literacy about glaucoma medications. Conclusion. Eye care providers did not always educate patients about glaucoma or glaucoma medications. Practice Implications. Providers should consider educating more patients about what glaucoma is and how it is treated so that glaucoma patients can better understand their disease. Even if a patient has already been educated once, it is important to reinforce what has been taught before.
PMCID: PMC4020294  PMID: 24868450
5.  Correlation of the Health Sciences Reasoning Test With Student Admission Variables 
Objectives. To assess the association between scores on the Health Sciences Reasoning Test (HSRT) and pharmacy student admission variables.
Methods. During the student admissions process, cognitive data, including undergraduate grade point average and Pharmacy College Admission Test (PCAT) scores, were collected from matriculating doctor of pharmacy (PharmD) students. Between 2007 and 2009, the HSRT was administered to 329 first-year PharmD students. Correlations between HSRT scores and cognitive data, previous degree, and gender were examined.
Results. After controlling for other predictors, 3 variables were significantly associated with HSRT scores: percentile rank on the reading comprehension (p<0.001), verbal (p<0.001), and quantitative (p<0.001) subsections of the PCAT.
Conclusions. Scores on the reading comprehension, verbal, and quantitative sections of the PCAT were significantly associated with HSRT scores. Some elements of critical thinking may be measured by these PCAT subsections. However, the HSRT offers information absent in standard cognitive admission criteria.
PMCID: PMC3748299  PMID: 23966721
Health Sciences Reasoning Test (HSRT); critical thinking; admissions; Pharmacy College Admission Test (PCAT)
6.  Glucocorticoid-Dependent Hippocampal Transcriptome in Male Rats: Pathway-Specific Alterations With Aging 
Endocrinology  2013;154(8):2807-2820.
Although glucocorticoids (GCs) are known to exert numerous effects in the hippocampus, their chronic regulatory functions remain poorly understood. Moreover, evidence is inconsistent regarding the long-standing hypothesis that chronic GC exposure promotes brain aging/Alzheimer disease. Here, we adrenalectomized male F344 rats at 15 months of age, maintained them for 3 months with implanted corticosterone (CORT) pellets producing low or intermediate (glucocorticoid receptor–activating) blood levels of CORT, and performed microarray/pathway analyses in hippocampal CA1. We defined the chronic GC-dependent transcriptome as 393 genes that exhibited differential expression between intermediate and low CORT groups. Short-term CORT (4 days) did not recapitulate this transcriptome. Functional processes/pathways overrepresented by chronic CORT–up-regulated genes included learning/plasticity, differentiation, glucose metabolism, and cholesterol biosynthesis, whereas processes overrepresented by CORT–down-regulated genes included inflammatory/immune/glial responses and extracellular structure. These profiles indicate that GCs chronically activate neuronal/metabolic processes while coordinately repressing a glial axis of reactivity/inflammation. We then compared the GC transcriptome with a previously defined hippocampal aging transcriptome, revealing a high proportion of common genes. Although CORT and aging moved expression of some common genes in the same direction, the majority were shifted in opposite directions by CORT and aging (eg, glial inflammatory genes down-regulated by CORT are up-regulated with aging). These results contradict the hypothesis that GCs simply promote brain aging and also suggest that the opposite direction shifts during aging reflect resistance to CORT regulation. Therefore, we propose a new model in which aging-related GC resistance develops in some target pathways, whereas GC overstimulation develops in others, together generating much of the brain aging phenotype.
PMCID: PMC3713214  PMID: 23736296
7.  The relationship between glaucoma medication adherence, eye drop technique, and visual field defect severity 
Ophthalmology  2011;118(12):2398-2402.
The purpose of the study was to examine: (a) how patient adherence and eye drop technique were associated with visual field defect severity and (b) how general glaucoma adherence self-efficacy and eye drop technique self-efficacy were related to visual field defect severity.
Cross-sectional study conducted at a single private practice site.
Patients on eye drops for their glaucoma.
We measured subjects’ adherence to glaucoma medications through Medication Events Monitoring System (MEMS) devices and assessed eye drop instillation technique by video-recording. We measured general glaucoma medication adherence self-efficacy using a 10-item scale and eye drop technique self-efficacy using a 6-item scale. Multivariable logistic regression was used to analyze the data.
Main outcome measures
Visual field defect severity.
Patients who were less than 80% adherent according to the MEMS caps were significantly more likely to have worse defect severity. Patients with lower scores on the general glaucoma medication adherence self-efficacy scale were also significantly more likely to have worse defect severity. Eye drop technique and eye drop technique self-efficacy were not significantly related to visual field defect severity.
Eye care providers need to assess patient adherence and work with those patients with poor adherence to find ways to improve their ability and self-efficacy in using their glaucoma medications.
PMCID: PMC3223548  PMID: 21856009
8.  Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension 
Nonsteroidal anti-inflammatory drugs (NSAIDs) may disrupt control of blood pressure in hypertensive patients and increase their risk of morbidity, mortality, and the costs of care. The objective of this study was to examine the association between incident use of NSAIDs and blood pressure in patients with hypertension.
We conducted a retrospective cohort study of adult hypertensive patients to determine the effects of their first prescription for NSAID on systolic blood pressure and antihypertensive drug intensification. Data were collected from an electronic medical record serving an academic general medicine practice in Indianapolis, Indiana, USA. Using propensity scores to minimize bias, we matched a cohort of 1,340 users of NSAIDs with 1,340 users of acetaminophen. Propensity score models included covariates likely to affect blood pressure or the use of NSAIDs. The study outcomes were the mean systolic blood pressure measurement after starting NSAIDs and changes in antihypertensive therapy.
Compared to patients using acetaminophen, NSAID users had a 2 mmHg increase in systolic blood pressure (95% CI, 0.7 to 3.3). Ibuprofen was associated with a 3 mmHg increase in systolic blood pressure compared to naproxen (95% CI, 0.5 to 4.6), and a 5 mmHg increase compared to celecoxib (95% CI, 0.4 to 10). The systolic blood pressure increase was 3 mmHg in a subgroup of patients concomitantly prescribed angiotensin converting enzyme inhibitors or calcium channel blockers and 6 mmHg among those prescribed a beta-adrenergic blocker. Blood pressure changes in patients prescribed diuretics or multiple antihypertensives were not statistically significant.
Compared to acetaminophen, incident use of NSAIDs, particularly ibuprofen, is associated with a small increase in systolic blood pressure in hypertensive patients. Effects in patients prescribed diuretics or multiple antihypertensives are negligible.
PMCID: PMC3502533  PMID: 23092442
NSAIDs; Hypertension; Blood pressure; Propensity score
9.  Patient Race, Reported Problems in Using Glaucoma Medications, and Adherence 
ISRN Ophthalmology  2012;2012:902819.
Objective. The objectives of the study were to (a) describe various factors potentially related to objectively measured adherence to glaucoma medications and self-reported glaucoma medication adherence self-efficacy and (b) examine the relationship between patient race, the number of patient reported-problems, and adherence in taking their glaucoma medication. This was a cross-sectional study conducted at two glaucoma subspecialist referral ophthalmology practices. Methods. We measured subjects' reported problems in using glaucoma medications, adherence to glaucoma medications utilizing the Medication Events Monitoring System (MEMS) devices, and general glaucoma medication adherence self-efficacy using a previously validated 10-item scale. Multivariable logistic and linear regression was used to analyze the data. Results. Seventy-one percent of patients self-reported at least one problem in using their glaucoma medications. White patients were more than 3 times more likely to be 80% adherent in using their glaucoma medications than non-White patients. Patients who had glaucoma longer reported significantly higher glaucoma medication adherence self-efficacy. Patients who reported more problems in using their medications had significantly lower glaucoma medication adherence self-efficacy. Conclusions. Eye care providers should assess patient reported problems and glaucoma medication adherence self-efficacy and work with patients to find ways to reduce the number of problems that patients experience to increase their self-efficacy in using glaucoma medications.
PMCID: PMC3914256  PMID: 24558595
10.  Patient decision making in the face of conflicting medication information 
When patients consult more than one source of information about their medications, they may encounter conflicting information. Although conflicting information has been associated with negative outcomes, including worse medication adherence, little is known about how patients make health decisions when they receive conflicting information. The objective of this study was to explore the decision making strategies that individuals with arthritis use when they receive conflicting medication information. Qualitative telephone interviews were conducted with 20 men and women with arthritis. Interview vignettes posed scenarios involving conflicting information from different sources (e.g., doctor, pharmacist, and relative), and respondents were asked how they would respond to the situation. Data analysis involved inductive coding to identify emergent themes and deductive contextualization to make meaning from the emergent themes. In response to conflicting medication information, patients used rules of thumb, trial and error, weighed benefits and risks, and sought more information, especially from a doctor. Patients relied heavily on trial and error when there was no conflicting information involved in the vignette. In contrast, patients used rules of thumb as a unique response to conflicting information. These findings increase our understanding of what patients do when they receive conflicting medication information. Given that patient exposure to conflicting information is likely to increase alongside the proliferation of medication information on the Internet, patients may benefit from assistance in identifying the most appropriate decision strategies for dealing with conflicting information, including information about best information sources.
PMCID: PMC3430944  PMID: 22943889
Medical decision making; medication adherence; doctor-patient communication; heuristics and biases; arthritis; information seeking
11.  Risk of hyperkalemia associated with selective COX-2 inhibitors† 
Pharmacoepidemiology and drug safety  2010;19(11):1194-1198.
Selective cyclooxygenase-2 (COX-2) inhibitors have been linked to cardiac death. The mechanism for this adverse effect appears to be by ischemic insult; however another mechanism could involve hyperkalemia. The objective of this study was to determine the effects of selective COX-2 inhibitors and non-selective nonsteroidal anti-inflammatory drugs (NSAIDs) on serum potassium concentration and the electrocardiogram.
A retrospective cohort study was conducted using propensity score matching of patients from an inner-city academic medical center at Indianapolis, Indiana. Two hundred and two patients prescribed selective COX-2 inhibitors were matched to 202 patients prescribed non-selective NSAIDs using propensity scores methods. Outcomes included change in serum potassium concentration from baseline and the risk of an abnormal electrocardiogram.
Compared to patients prescribed non-selective NSAIDs, those prescribed a selective COX-2 inhibitor had a higher risk of serum potassium increase greater than 5 mEq/L (OR, 2.56; 95%CI, 1.03–6.36). However, patients prescribed selective COX-2 inhibitors had no greater risk of electrocardiogram abnormality (OR, 1.16; 95%CI, 0.74–1.82).
Selective COX-2 inhibitors may have a greater risk of hyperkalemia than non-selective NSAIDs. This study was exploratory with small numbers of patients. Further studies are needed to confirm these results and any association with cardiovascular events.
PMCID: PMC3018679  PMID: 20842761
hyperkalemia; NSAIDs; selective COX-2 inhibitors; retrospective cohort study; propensity score
12.  The Status of PhD Education in Economic, Social, and Administrative Sciences Between 2005 and 2008 
To describe the funding, education, enrollment, and graduation patterns from economic, social, and administrative sciences PhD programs in colleges and schools of pharmacy in the United States.
Economic, social, and administrative sciences PhD programs were identified from the American Association of Colleges of Pharmacy (AACP) Web site. A 41-item online survey instrument was sent to the director of graduate studies of each identified program. Only programs offering a PhD degree were included in the study.
Of the 26 programs surveyed, 20 (77%) provided useable responses to the survey instrument. Approximately 91% of PhD programs guarantee funding to incoming students with an average commitment of 2.9 years. On average, students were paid a stipend of $18,000 per year for commitments to research and teaching assistantships, each averaging approximately 2 years in length. Programs admitted an average of 3.5 students per year and graduated approximately 85% of entering students. The majority of students are non-US citizens and accept positions in either academic or industrial positions after graduation.
Most economic, social, and administrative sciences PhD programs guarantee funding to incoming PhD candidates. Programs offering funding packages significantly below the average may be at a competitive disadvantage. It is unclear whether the number of students graduating from PhD programs is adequate to fulfill academic and industrial needs.
PMCID: PMC2972521  PMID: 21088732
graduate education; academia; social and administrative sciences; doctor of philosophy
13.  Pre-Dialysis Chronic Kidney Disease: Evaluation of Quality of Life in Clinic Patients Receiving Comprehensive Anemia Care 
Anemia is common in chronic kidney disease (CKD), and suboptimal management of anemia can lead to serious health complications and poor quality of life.
1) To describe health-related and overall quality of life among patients entering a clinic focused on anemia management; 2) to compare their baseline quality of life with other relevant populations; 3) to explore predictors of quality of life prior to anemia management; and 4) to explore changes in quality of life over 1 year for patients managed in the clinic.
The Kidney Disease Quality of Life questionnaire – short form (KDQOL™-SF) was used to measure kidney disease specific and overall quality of life in a cohort of pre-dialysis CKD patients (n=79) enrolled in the clinic from January 2003 to September 2004. Baseline measures were compared to previously published measurements. The influence of demographic and clinical characteristics on baseline quality of life was explored. Changes in quality of life were evaluated over time.
Patients with CKD entering the clinic had lower overall quality of life compared with estimates from the general US population (physical composite 35.7 vs. 48.4 and mental composite 46.0 vs. 50.2, respectively). Clinic patients had better kidney disease specific scores than patients with end stage kidney disease. General quality of life scores were similar regardless of kidney disease severity, with the exception of physical functioning which was lowest for patients with end-stage disease. Hemoglobin was the only factor predictive of quality of life. Over time, quality of life improved among patients managed in the CKD clinic, with statistically significant improvements in sleep (change of 6.2 ± 15.2; p < 0.05) and social function (change of 11.6 ± 27.7; p < 0.05).
Patients with anemia of chronic kidney disease reported reduced quality of life compared to populations without kidney disease, but better quality of life compared to populations with end stage kidney disease on dialysis. Quality of life generally improved among patients managed in the multidisciplinary anemia clinic.
PMCID: PMC2722114  PMID: 19524862
Quality of life; chronic kidney disease; anemia; SF-36; KDQOL; multidisciplinary
14.  Practice Settings, Job Responsibilities, and Job Satisfaction of Nontraditional PharmD and BS Pharmacy Graduates 
To assess differences in the practice of pharmacy and in job satisfaction between graduates of a nontraditional doctor of pharmacy (PharmD) program and a bachelor of science (BS) in pharmacy program.
Two separate survey instruments were mailed to 293 PharmD graduates and 293 BS graduates.
Two hundred fourteen (73.0%) of the 293 nontraditional PharmD graduates and 189 (64.5%) of the 293 BS graduates completed the survey instruments. Nontraditional PharmD graduates expressed greater satisfaction, both in their current position and with pharmacy as a career, compared to BS graduates. Nontraditional PharmD graduates were more likely than BS graduates to practice in a hospital and have more clinical responsibilities.
Nontraditional PharmD graduates are more likely to have greater satisfaction with their job and with pharmacy as a career compared to BS-trained pharmacists.
PMCID: PMC2690895  PMID: 19513171
nontraditional PharmD degree; job responsibilities; job satisfaction
15.  The Structured Interview and Interviewer Training in the Admissions Process 
To determine the extent to which the structured interview is used in the PharmD admissions process in US colleges and schools of pharmacy, and the prevalence and content of interviewer training.
A survey instrument consisting of 7 questions regarding interviews and interviewer training was sent to 92 colleges and schools of pharmacy in the United States that were accredited or seeking accreditation.
Sixty survey instruments (65% response rate) were returned. The majority of the schools that responded (80%) used interviews as part of the PharmD admissions process. Of the schools that used an interview as part of the admissions process, 86% provided some type of interviewer training and 13% used a set of predefined questions in admissions interviews.
Most colleges and schools of pharmacy use some components of the structured interview in the PharmD admissions process; however, training for interviewers varies widely among colleges and schools of pharmacy.
PMCID: PMC2064881  PMID: 17998980
structured interview; interview; interviewer training; admissions

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